Adhesions are the formation of fibrous attachments between two apposing surfaces, and are often formed during the dynamic process of healing of the incision and tissue trauma after surgery. The initiation of the adhesion begins with the formation of a fibrin matrix. The ischemic conditions caused by surgery prevent fibrinolytic activity to dissolve the matrix, and the fibrin persists. Wound repair cells then turn the matrix into an organized adhesion, often having a vascular supply and neuronal elements.
Adhesions are a particular problem in gastrointestinal and gynecological surgery, leading to post-operative bowel obstruction, infertility, and chronic pelvic pain. The barrier method of reducing post-surgical adhesions is most commonly used (Arnold, P. B., Green, C. W., Foresman, P. A, and Rodeheaver, G. T. (2000) “Evaluation of resorbable barriers for preventing surgical adhesions”Fert Steril 73, 157-161; Osada, H., Takahashi, K., Fujii, T. K., Tsunoda, I., and Satoh, K. (1999) “The effect of cross-linked hyaluronate hydrogel on the reduction of post-surgical adhesion reformation in rabbits” J Int Med Res 27, 233-241). For example, Seprafilm™ (Genzyme) is a bioresorbable membrane prepared from hyaluronan (HA) and carboxymethyl cellulose (CMC) that reduces adhesions. Seprafilm, however, has poor handling properties and a short residence time that contributes to loss of efficacy. An internally esterified form of HA (ACP™ gel, Fidia Advanced Biopolymers) and a 0.5% ferric iron jonically crosslinked HA gel (Intergel™, Lifecore Biomedical) are newer barrier materials which do not accelerate healing of the incisions. Described herein are composites that inhibit or reduce adhesion between two or more tissues.